Accountability and reporting at the HSE

The HSE publishes an annual National Service Plan which shows the organisation's intentions for the coming months, including delivery priorities and external contributing factors.

The current plan is guided by:

Accountability within the HSE

The HSE’s Chief Executive Officer (CEO) is accountable to the HSE Board. The Board is then directly accountable to the Minister for Health for the HSE’s performance.

The Board has several committees to assist and advise it, including a Planning and Performance Committee. This committee continues the chain of accountability through the organisation using its Performance and Accountability Framework (PAF).

The framework sets out how services and individuals in the HSE are held to account for their performance.

The services and individuals it covers are:

  • the hospital groups
  • community healthcare organisations (CHOs)
  • the National Ambulance Service (NAS)
  • the Primary Care Reimbursement Service (PCRS)
  • the heads of other national services
  • individual managers

What the framework does

The framework is an internal management document that ensures that the healthcare system has clear authority, responsibilities and accountability.

It measures performance by looking at:

  • access to and integration of services
  • the quality and safety of those services
  • specific financial, governance and compliance requirements
  • whether the efforts of our whole workforce have been effectively harnessed

Performance and Accountability Framework 2023

How performance is monitored and reported

Hospital group CEOs, CHO Chief Officers, the Head of the NAS, the Head of the PCRS and the heads of other national services are 'accountable officers'.

An accountable officer is responsible for the performance of the service they manage, lead or deliver. They must also make any necessary performance improvements and do this within budget.

Accountable officers sign a performance agreement showing what they are responsible for and how they will be held to account. The HSE’s National Performance Oversight Group (NPOG) then has responsibility for judging their performance.

Monthly performance information is provided to NPOG and to accountable officers, and a performance profile is produced. This includes details of waiting lists, and urgent and emergency care. The group meets every month to review performance across the health service.

Quarterly performance reports are also produced, which are published by the HSE.

An overview report of areas of escalation, where performance is falling short, and the actions planned to deal with this are also provided to the Department of Health and the Minister monthly.

Where performance falls short - escalation

The escalation process within the framework deals with areas where performance is falling short of expectations.

In the early stages of performance falling short of targets, the accountable officer is responsible for intervening, supporting and monitoring the issue. If there's no improvement and the problem continues, the Performance Management and Improvement Unit (PMIU) will become involved.

The HSE has formed this unit to provides expert assistance and targeted financial investment. It helps providers reach their performance targets where there are challenges.

If a problem becomes critical, or underperformance is putting quality, safety and financial stability at risk, an escalation to or by the Chief Operations Officer or the Chief Executive Officer is triggered. This is expected to happen very rarely.

Every month, NPOG provides an ‘Escalation Report’ to the HSE’s Chief Executive Officer.

The report:

  • shows areas of performance that are at the higher levels of escalation
  • records the actions that have been agreed
  • records whether actions have been delivered or not

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